Saturday, May 31, 2008

My previous two summer field ed placements have been parish placements in rural towns of North Carolina, so this summer is the first time I have served in an agency placement outside of the church since I worked with Confrontation Point Ministries (Crossville, TN) during undergrad. Going into this summer I can say that I have definitely felt called to and led to serve in this area of ministry to those who face terminal illness and the end of their life due to my involvement of working at ICEOL this past school year which led to a growing desire to be ministry to/with the sick in a hands-on way. The part of ministry I missed over the past school year working with ICEOL was that my time was spent in an office where my work affected the training of doctors, nurses, social workers, chaplains, ect who would in turn work with the sick, but not getting to be with sick myself, not getting to hear their stories, hold their hand and journey with them. I was very excited that my field ed placement for the summer worked out so that I could continue my work with ICEOL, but also that a majority of my time would be with Duke Hospice (on the front lines, so to say) journeying and being with people.

As I sat in field ed orientation, watching my friends and classmates get pumped for their parish field ed placements (I'd say over 90% of students are in parish placements), I began to wonder if I would miss being in a parish placement this summer, as I had the previous two summers. Would I miss preaching? Would I miss leading worship? Would I miss assisting with communion? Would I miss being involved with ordering the life of the church? These questions began to swarm around my head as I sat in Goodson Chapel for orientation and carried with me as I prepared for my own field ed placement. Since I first identified God's calling on my life for ministry I come back to the question of parish ministry time and time again, and over and over again I have "decided," possibly convincing myself, that God is not calling me to parish ministry, to pastor a church. Why does this question continue to surface time and time again so that I have to wonder if I really am running away from parish ministry.

It is amazing how God really does talk to us when we take time to listen, and by listen I mean really listening. I am still struck at how although I consider myself more comfortable with silence than most that I still do a good job of filling my life with noise and distraction leaving little to no time of real silence for meditation and reflection. I recall my time with CP and going caving where we got to the devo spot deep in the cave, sat in a circle, turned out our lights and sat in silence. The ringing in our ears showed us how weird it was to have the absence of noise, noises we pay little attention to but saturate our lives, and it seemed almost as if our ears were straining to hear some noise because they were so used to being bombarded. The first week of field ed I spent a lot of time alone because my roommate is gone for her summer placement and many of my friends from school are dispersed across the country (and world) or were out of town, so I was left to actually face my own thoughts and questions.

I think I am realizing how much I miss being in a parish placement this summer, and while I do feel called to be in the placement I am this summer, that my heart may in fact be for parish ministry. One evening that first week I was struck clearly as to the reason if I am in fact running away from being a pastor. It is simply because I am scared. Being the pastor of a church is scary, especially as a young single female pastor. I catch myself every so often desiring to live in a rural area and my heart is definitely for the smaller churches (no mega churches for me please!) and while pastoring a small rural church doesn't sound very exciting for some it sounds like a wonderful life to me (despite the many challenges). This passion for the rural church is a major part of the reason for my transfer in membership to the Western North Carolina Conference of the UMC. Obviously these are questions I will probably continue to discern for the rest of the summer, and even for my lifetime, but I do hope and pray God will continue to shed light upon my questions as to where He will lead me next. I covet your prayers as I discern a calling to parish ministry following graduation from seminary.

Friday, May 30, 2008

I realized that some may know little or nothing about what hospice care is and so I've decided to post some general info about hospice to educate folks about hospice, and possibly dispel any misconceptions floating around about hospice. I think hospice is pretty amazing and not sure why people would not want to "take advantage" of this great care which is available.

Palliative care specializes in managing the symptoms associated with a terminal illness - physically, emotionally and spiritually. Patients are given comfort oriented care rather than curative care.

Our Services

Terminal illness can be exhausting for both patients and caregivers alike. The demands may simply be too great for loved ones to manage alone. Our interdisciplinary team ensures that all patient and family needs are met.

Nurses

Our Registered Nurses and Licensed Practical Nurses provide direct patient care and collaborate with the interdisciplinary team to ensure symptoms are managed effectively.

Social Workers

Our social workers will assess the psychosocial needs of the patients and their loved ones to ensure that their needs are met. They can also provide assistance with locating community services and resources that appropriatly meet their needs.

Chaplains

Our chaplains are available, upon request, to assess patient and family spiritual needs. They can also coordinate with local clergy to provide support for patients, families and the community.

Nursing Assistants

Our Nursing Assistants provide personal care assistance and support for patients and their families.

Volunteers

Provide a broad range of services to meet patient and family needs. Volunteers provide a caring presence to patients and emotional and practical support for families and caregivers.

Bereavement Counselors

Support family members/caregivers up to one year following a patient's death. Our Bereavement Counselors provide both group and individual counseling for family members and friends.

Hospice care addresses the physical, emotional and spiritual pain of terminally ill persons and their family members. Hospice focuses on "palliative" measures (comfort-oriented measures as opposed to cure-oriented measures) to enhance the quality of life, for both patient and family, during their remaining time. A key focus in Hospice care is to keep the patient in familiar and comfortable surroundings. Managing symptoms in a home environment (whether "home" means their personal home or a facility) avoids lengthy hospitalizations and serves to make Hospice a more cost-effective alternative to unnecessary, and often expensive, interventions.

Hospice incorporates the patient's family into the unit of care. Their psychosocial needs, as well as those of the patient's are addressed by social workers. Hospice chaplains are also available to address spiritual issues or concerns. Bereavement professionals have contact with the family to guide them through the difficult transition that accompanies the death of the loved one. Volunteers expand Hospice services in a variety of ways, such as providing respite to patient family members or running errands for the family. In addition, the presence of volunteers is a mandated Medicare standard wherein five percent of the total annual patient care hours are volunteer hours.

Is Hospice like home health?

Well, yes and no. . ."yes" in the respect that home Hospice care, like home health care, focuses on caring for the patient at home. Also "yes" in the respect that both are cost-effective alternatives through their decrease in or elimination of costly hospital stays. But, there are more differences than similarities.

The primary difference is that home health care is largely focused on rehabilitative care, while Hospice is appropriate only for those with limited life expectancies. Hospice also specializes in controlling the pain and symptoms unique to terminal illnesses. Over the years, Hospice methods of pain control and symptom management have come into their own as a specialized body of knowledge. Hospice considers the entire family, not just the patient as the "unit of care."

Where does the idea of Hospice care come from?

The modern concept of Hospice care began with a young woman named Cicely Saunders who, as a clinical aide, became very close to a gentleman for whom she was caring. As the man's condition progressed, they had many conversations concerning the needs of a dying person. They discussed the need to address pain on all levels -- physical, emotional and spiritual -- and how by doing so, the quality of life would be enhanced for those with limited life expectancies. When the gentleman died, he left Cicely Saunders a portion of his estate to carry out their ideas. Cicely Saunders used the money to complete medical school, knowing she would never have the credibility to advance their Hospice concept as a lay person. Dame Cicely Saunders began the first modern-day Hospice, St. Christopher's, in London in 1967.

"Hospice," incidentally, comes from the same Latin root from which words such as "hotel," "hostel" and "hospital" are also derived. During medieval times, a Hospice was a place of shelter for travelers. The idea remains in the modern use of the word - "Hospice" as a place of shelter for those journeying through the final months, weeks and days of their lives.

Is Hospice a sort of Kervorkian-type thing?

No, Hospice neither hastens nor postpones death. The National Hospice and Palliative Care Organization has responded officially to issues surrounding the Jack Kervorkian case in particular and physician-assisted suicide, in general. Hospice care is designed to control pain and symptoms associated with terminal illness, neither prolonging life nor hastening death. In this way the degree of suffering which might prompt some to consider assisted suicide would be lessened. The time patient and family spend together in the patient's last days can be a very positive experience.

Hospice is about choice and maintaining quality of life in the face of death. When looking at the issue of physician-assisted suicide, the issues are far from black and white. While recognizing this issue in present day thought, we maintain that good Hospice care controls the suffering of a large percentage of those who might opt for suicide to end or avoid pain. Even so, many people remain unaware of Hospice care and how Hospice can help.

Is Hospice just for cancer patients?

No, Hospice care is appropriate for anyone facing a limited life expectancy. Approximately half of people on Hospice are dying from illnesses such as emphysema, cardio-pulmonary problems, Alzheimer's disease, and other system disorders.

How is a person referred to Hospice?

Referrals to Hospice come from a variety of places: the patient's physician, discharge planners at hospitals (in consultation with the patient's attending physician), nursing homes, family members, friends, members of the person's church, co-workers, home health agencies. All a person has to do to make a referral is to call our office, with the prospective patient's permission. Hospice will contact the referred person's physician to see if in fact they have a terminal prognosis. (Hospice cannot contact the patient's physician without the express approval of the patient.) Only then is the family contacted to explain the Hospice program and asked if they are interested in our assistance. If so, an assessment visit is arranged, at which time, if appropriate, the person may elect to be admitted.

Who is eligible?

As a Medicare/Medicaid provider, Duke Hospice is subject to guidelines for admission which require: 1) the patient has a prognosis of 6 months or less IF the disease runs its normal course, and the physician confirms that prognosis: 2) the patient, patient's family and the physician agree upon a non-aggressive course of treatment. In other words, there has been agreement that curative measures be ended and comfort-oriented treatment becomes the focus of care.

Hospice evaluates each referral for its "appropriateness." Hospice does not provide 24-hour in-home care, but does have nurses on-call twenty-four hours a day. Hospice social workers can help arrange 24-hour care through hired nurses’ aides or similar contract personnel. It is not mandatory that a patient have a primary caregiver, but this factor along with the patient's physical condition and support system, is taken into consideration at time of admission. When remaining at home is no longer feasible for a patient without a primary caregiver, arrangements can be made to admit the patient to one of many local care facilities with which Hospice works.

If you sign on with Hospice, do you give up your own physician?

No. The intent of the Hospice program is to help the physician with care at the end of life. The doctor is notified of patient status changes, and is involved in the care plan. Patients may make visits to their doctor's office or clinic if needed.

Do physicians get paid if their patients become Hospice patients?

Physicians are reimbursed for office visits as usual. Time spent on the phone in consultation with Hospice staff concerning status or prescription changes may also be billed to Medicare. The doctor is responsible for billing that time to Medicare.

Why do you have a Hospice program for nursing homes?

Nursing homes are no longer places where "old folks go to die." Many focus on rehabilitative care and nursing home staff are not always familiar with terminal/palliative care needed by residents with limited life expectancies who choose this approach to care. The Duke HomeCare & Hospice's PARTners (Palliative Care in Alternative Residences) Program allows people who call a long-term care facility "home" to receive the benefits of Hospice care and avoid relocation to hospitals. Our staff works with nursing home staff on issues of death, dying and bereavement so that they, as the primary care givers for their residents, can offer care for terminally ill residents.

How many people do you serve a year?

During 2006-2007, Duke Hospice served 865 terminally ill persons.

How is Hospice funded?

Approximately 85% of our Hospice receipts come from patient care reimbursement, including Medicare, Medicaid, private insurance, State Employees Health plan and patient fees. The remaining 15% comes from community support.

How do you raise money from the community?

Hospice receives many donations in memory of Hospice patients. The Duke HomeCare & Hospice (DHCH) development office is responsible for additional fund raising. They accomplish this through direct mail campaigns, the Service of Endearment Program and other person-to-person fundraising events, including the annual Oh, What A Night gala.

When I give a donation, where does the money go?

Donations to Duke Hospice are used exclusively by DHCH for hospice and help provide care to Hospice patients in our area who are uninsured and underinsured. Such contributions are critical to our mission that no one ever be turned away from hospice because of an inability to pay.

Does Hospice provide bereavement support only to family members of Hospice patients or are there programs for the public as well?

Hospice offers support to the families of Hospice patients for a year following the death of their loved one. Bereavement Counselors are in touch to evaluate the survivor's grief process, and to direct them to additional counseling if they experience complicated grieving. Bereavement Services are offered to the community at-large as well as to Hospice families throughUnicorn Bereavement Center in Hillsborough.

What is Camp ReLEAF?

Camp ReLEAF is a bereavement camp for children in grades 1-8 who have experienced the death of a family member or friend. The camp is designed to allow kids to express their feelings about the loss, and meet peers who have endured similar experiences. Camp ReLEAF has been held by Hospice for the last ten years and is not limited to children of hospice patients.

Does Hospice use volunteers?

Volunteers serve Hospice by working with patients and families, working in the office, helping with special events or other fund raising efforts, manning booths at health fairs and speaking on the behalf of Hospice. Volunteers are needed in every department of the agency in addition to those who train to serve patients.

How do I become a volunteer?

By calling the Volunteer Supervisor for information. Volunteer training classes are held several times a year for those who wish to volunteer with patients and their families. Office volunteers and others do not need to go through patient care training (although it is still very informative).

Why does Hospice need an Inpatient Care Facility?

Hospice at The Meadowlands provides service to individuals in need of acute care. In recent years, what Hospice has been asked to do is provide intensive physical, emotional and spiritual interventions for dying patients and their families during an increasingly limited time between admission to Hospice and death. Hospice service is most intense during the first two weeks of admission and the last two weeks of life. Additional patient care costs include expenses for medication and equipment supply. Initial nursing, social work, and chaplain visits require thorough assessment as well as documentation processes for patient data initialization. The Inpatient Care Facility is devoted to patients in need of symptom management that cannot be handled at home, i.e. when death is imminent and the patient and/or caregiver is unable to cope at home or if there is the need for complex patient and/or family instruction to prepare for transfer from the hospital to the patient's home. The facility at The Meadowlands is a cost-saving alternative to admitting the acute patient to the hospital. Thus, service at the Inpatient Care Facility is geared for shorter rather than extended lengths of stay.

Where is the Inpatient Care Facility?

Hospice at The Meadowlands is on an 11-acre tract near the Sportsplex in Hillsborough. A century-old farmhouse currently stands on the property, and has been renovated to serve as the Unicorn Bereavement Center. The six-bed Inpatient Care Facility is located directly behind the old home and admitted its first patient in April, 1996. Volunteers play a key part in the services offered by the Inpatient Care Facility.

The new Durham Inpatient Care Facility will be build beside of the historic Teer Home on Roxboro Road. It will be centrally located in Durham County, and on the DATA bus line to allow more patients and families the opportunity to take advantage of the benefits of inpatient hospice care.

Well, this is my first venture into the world of blogging. I'm Kevin Todd and am an M.Div student entering into my final round at DDS. This summer I’ve received a placement at an agency called Partners in Caring. Here’s a brief description of the organization taken from its webpage:Partners In Caring (PIC) is a grant-funded component of the Duke University Medical Center Pastoral Services Department and the Duke University AIDS Research and Treatment Center (DART). It was initiated to bring an end to the personal and spiritual isolation experienced by people living with HIV/AIDS (PLWHA), their families, and their friends, particularly in rural North Carolina.

Partners in Caring has a variety of programs through which it serves those living with HIV/AIDS. If you’d like to check out some more information about Partners and Caring and its programs see www.dukehealth.org/Services/partners_in_caring.

My first week at PIC I was glad to find out that I had some time to read up on HIV/AIDS. Artie, my supervisor, provided a few quality resources that helped me establish a foundational understanding of the disease and some of its social factors and statistics. Some of the statistics are pretty staggering:

North Carolina statsStatewide: Since 1983 there have been 32,582 reported cases of HIV/AIDS in North Carolina. Currently there are 21,593 known cases of people living with HIV/AIDS in NC.*Durham: Durham is listed as having the fifth highest amount of HIV disease cases out of all the counties in NC; there are 1,240 people that are known to be living with HIV/AIDS in Durham county.* (These and other stats can be found at: www.ncpublichealth.com)

*Note that these are known cases; estimated figures account for the fact that around 25% of people living with HIV/AIDS do not know they are infected. (www.cdc.gov/hiv)

US stats:At the end of 2003 there was an estimate of 1 to over 1.1 million people living with HIV/AIDS. And as of 2006, the cumulative estimated number of deaths of people with AIDS in the US was 565,927. (www.cdc.gov/hiv)

International stats:At the end of 2007, it was estimated by UNAIDS that there were 33.2 million people infected with HIV worldwide. On a global scale, everyday almost 6800 people are infected with HIV and nearly 5700 die from HIV related illnesses. (More global statistics and information can be found at www.UNAIDs.org)

It is quite evident that there is a great need in the area of HIV/AIDS; it is a need that calls us to work toward treatment and prevention, and it cries out to us to respond with compassion, genuine care, and solidarity. Unfortunately it seems that many parts of the Body of Christ have tended to turn the opposite way, responding in ignorant judgment, anti-hospitality, and perhaps the most damaging and pervasive response…silence.

This past week we had a joint commissioning service with the interns and residents from the pastoral services department. Part of the litany with which I was commissioned said:We wish to affirm and bless your call to serve as an intern in the wider community with those deeply impacted by HIV, STD's and substance abuse. You have been chosen to offer pastoral care and other worthy services with those who face discrimination and isolation because of the stigma of their conditions. You are commissioned today to live the words of the Christian Testament, "Just as you did it to one of the least of these who are members of my family, you did it to me."

I hope and pray that my time with Partners in Caring will give me the opportunity to learn how to respond to the needs of those living with HIV/AIDS and others like it, primarily as it will open my eyes to see those whom we tend to look past and to hear the ones we often ignore. May God grant me grace to look and listen. And I hope that the availability, openness, and obedience of “Here I am”—that phrase often heard in response to God’s voice in the OT—will be evident and true of my posture this summer.

Monday, May 26, 2008

For those not familiar with the words to the two songs I mentioned in the previous post...

"Precious Lord Take My Hand"

Precious Lord, take my hand,

Lead me on, let me stand,

I am tired, I am weak, I am worn;

Through the storm, through the night,

Lead me on to the light:

Refrain:

Take my hand, precious Lord, Lead me home.

When my way grows drear,

Precious Lord, linger near,

When my life is almost gone,

Hear my cry, hear my call,

Hold my hand lest I fall

Refrain

When the darkness appears

And the night draws near,

And the day is past and gone

At the river I stand,

Guide my feet, hold my hand,

Refrain

"It It Well With My Soul"

When peace, like a river, attendeth my way,

When sorrows like sea billows roll;

Whatever my lot, Thou has taught me to say,

It is well, it is well, with my soul.

Refrain:

It is well, with my soul,

It is well, with my soul,

It is well, it is well, with my soul.

Though Satan should buffet, though trials should come,

Let this blest assurance control,

That Christ has regarded my helpless estate,

And hath shed His own blood for my soul.

Refrain

My sin, oh, the bliss of this glorious thought!

My sin, not in part but the whole,

Is nailed to the cross, and I bear it no more,

Praise the Lord, praise the Lord, O my soul!

Refrain

And Lord, haste the day when my faith shall be sight,

The clouds be rolled back as a scroll,

The trump shall resound, and the Lord shall descend,

Even so it is well with my soul

Refrain

These happen to be two powerful songs in my own life that have spoken to me before, but I think the words are very appropriate for this setting, for those facing the end of their life and the peace and comfort that God can give to us on our final journey.

I can hardly believe that the first week of field ed is already over and there's only nine more to go! I'm gonna have to get on the ball with this blog to keep you folks updated more often because I have so much to say! ;o) Well with one week under my belt I can say that this will be an amazing summer because I have already been pushed far out of my comfort zone and witnessed many beautiful moments in merely a week's time.

Much of my work at ICEOL remains the same as it has been during the academic year working on the APPEAL conferences. The next APPEAL conference will be in Dallas, TX on July 11-12th so we are now beginning to feel the crunch of time as we make sure marketing material goes out, finalize logistics and work on making this conference happen. A majority of my job for APPEAL is spent in working with the faculty who will be presenting in putting together the various powerpoint slides in a master show, having them double/triple check to make sure those are the slides they want to use and that they are in the correct order, and what portion(s) of the DVD they would like to show and where in the presentation it will be shown. We have decided to continue to improve the flow of the presentations, which is the conference, by embedding the movie segments into the actual presentation. This means working a bit more in advance on deciding what portions will be show because it takes time to make these files and not something that can be changed the night before the conference. The faculty also vary from conference to conference, and though same remain the same there will be new faculty so there are significant changes for each conference.

As much as I enjoy my time with ICEOL I am looking forward to spending most of my field ed time with Duke Hospice where I get to be with people. The work I do with ICEOL contributes to educating doctors, nurses, chaplains, social workers, ect in the APPEAL curriculum and in turn hopefully affecting their work with those in palliative care, but I also desire to be on the "front lines" with those being affected by palliative care. There is much to share about my first week with Duke Hospice. My time each week will consist of visiting patients and writing documentation about the visit, meetings including a weekly supervisor meeting, writing a verbatim for weekly supervisor meeting (much like a verbatim for CPE), researching pediatrics and hospice (Duke Hospice hopes to be able to do more of this), reading several books my supervisor has selected and writing a reflection upon them, and various other tasks. In preparation for being given four patients to be in charge of for the summer (meaning, taking care of their spiritual needs) I attended hospice volunteer training last weekend (Fri-Sun) to get a good overview of hospice and see the role of the hospice volunteer. I will also be spending significant time shadowing Jodi and Danny, the two chaplains, as well as a nurse, social worker, ect to see the various parts of hospice that come together to care for each patient. Hospice care is based around an interdisciplinary team consisting of the doctor, nurse, social worker, chaplain and volunteer who care for the patient, so if you go on hospice care you get all of this! (If you want it, of course) I will also spend some time at the ICF (In-patient Care Facility), a short term stay facility, and the bereavement staff in charge of bereavement care, which is available to the family for up to thirteen months following the death of their loved one. More about the different things I do and have learned about hospice in general as I go through the summer, but for now onto the stories!

On Tuesday I shadowed Jodi to get a taste of what the role of the hospice chaplain is, and the identity I will be putting on for the summer. The role of the hospice chaplain is to care for the spiritual needs of the patient and patients are typically seen by the hospice chaplain once a month, and more if requested or a crisis occurs. Hospice believes that everyone has spirituality, which is different than religion, and so it is the chaplain's job to address their spiritual needs. I met a woman who I will be visiting with this summer named Esther* who is an elderly African American woman with lung cancer. Esther has been in hospice care for over a year and has a fairly positive outlook on life despite living with this terminal illness and the pain that comes with it. Since she came into hospice care her ability to walk around and care for herself has decreased, but she is still able to do much for herself. She is quite talkative and excited to meet with me so I am looking forward to my time with her. She was very excited to tell me about herself and show off her oxygen machine. While we were there Jodi got Esther to sing "Precious Lord Take My Hand" with her and it was incredibly touching moment to see this woman join Jodi in song that was familiar to her. Although Esther felt as if she couldn't sing anymore because her voice was weak she knew the words and joined in when she could.

The next woman I met is Deborah*, and elderly woman with dementia who lives with her son and daughter-in-law, but is primarily cared for each day by her granddaughter who lives next door with her family. Deborah only speaks a few short sentences a day, but seems to still recognize her name and be aware of what was going on around her. As Jodi and I sat talking with her granddaughter, keeping Deborah involved in the conversation, I noticed that she seem to listen to us and respond somewhat through making eye contact and smiling. I was struck at how easily the granddaughter continued to keep Deborah as part of the conversation even if we were not speaking directly to her. Being told Deborah only speaks a few sentences a day I considered it a very special moment that as Jodi and I took turns saying goodbye to her that she responded to each of us with a clear "goodbye" accompanied by a smile. She had been quiet during our entire visit, talking to her and each other so to experience her words was very special.

Our next travels brought us to a facility where I met a elderly woman, Rachel*, who is "actively" dying of congestive heart failure, and has continued to hang out over a week longer than expected. As I held her hand and Jodi sang "It Is Well With My Soul" she closed her eyes and continued to grasp my hand. At that moment I felt as if I were standing on holy ground, truly sacred space, to be invited into a place with someone so close to death and so appreciative that we have come to be there with them, even as a complete stranger. I was amazed at how eager she was to hold my hand tightly, not wanting to let go, and let me be close to her and look into my eyes and thank me for being there.

Also in this facility Jodi and I met with an elderly man, Peter* who greatly impacted my day. This was the first time meeting Peter for the both of us, and Jodi received an important call as we stepped in the room so she let me stay with Peter. I was struck when Peter was not satisfied with holding my hand but gently grabbed my other hand and arm as well as if he needed human touch. Later we realized we had walked into his room without the needed gloves and gown (more for our protection due to a small infection) and I was saddened as I re-entered the room now covered with gloves and a gown which would interrupt the physical touch he seem to eagerly desire. While the gown and gloves were for my safety, and possibly his own, it hurt that this may continue to lead to his feeling of separation from people as he approached the end of his life. His family was unable to visit much except for short visits on the weekends and so it seemed that Peter was very lonely. During the time Jodi was away Peter struggled to talk to me. He told me that I was a beautiful girl, and that he was having a hard day, he seemed to be frustrated with not being able to say what he was feeling. It was as if the connection between his thoughts/feelings and being able to speak about that had been broken. We found out that Peter was a retired minister and so we asked if he would like to lead us in prayer, and he did so very willingly. It was a beautiful prayer because it was so honest and real, as he prayed to God about not understanding what was going, and for not understanding the not understanding. His prayer brought me to tears and a man I had known for 10 minutes would be so real and honest in front of complete strangers, and that even as a minister he was able to be honest about his struggles. Peter told Jodi that God was working on him through her and there was a sense that our visit greatly impacted him. Also noteworthy was Peter's humor, despite his great frustration with what he was experiencing and not being able to say what he needed/want to say he joked with Jodi, I and his aid. On a personal note, his humor reminded me greatly of my own father's humor, and how my dad had continued to keep his humor even as he drew close to his death. I feel as if Peter will play a special role in my summer and I look forward to meeting with him again.

Our last visit on Tuesday brought us to a man, *Gideon, who everyone thought was going to pass away several days earlier but continued to hold on. We visited some with his daughter before going in to see him. When I met Gideon he remarked to me about the sunshine coming through the window, how he loved it and wished he could be outside in it. Jodi asked Gideon what he wanted her to pray for and so Jodi led us in a prayer for relief of pain and for life. Gideon also surprised me by adding his own words to her prayer, praying to God for strength, and again, as a completely stranger, I witnessed a very real and honest prayer. I stood on sacred ground as Gideon was so thankful for our presence and saying that he believed it was "the beginning of the end." As we said goodbye to him he told Jodi that he loved her, and he also told me that he loved me. The look in his eyes as he held my hand, looked at me and told me he loved me said that it meant a great deal to him that we had come to see him. I again was amazed by the openness and the great impact of simply being present with people.

And that was just Tuesday :o) On Wednesday I shadowed Danny, the other hospice chaplain. We visited a different facility to check on one of his patients and meet another woman I will be "in charge of" for the summer. With our first visit I witnessed how the role of the chaplain can involve being an advocate for the patient in making sure they are properly cared for. Part of hospice care involves pain management, not doping people up into some drug induced fog so they can't feel pain, but controlling and managing their pain so they can live out the rest of their days as comfortably as possible, and the patients have control over the extent they would like their pain managed. The first woman was in obvious pain and so Danny made sure the nurse was notified and would address her pain, and find out what exactly was the cause of her pain. Something I learned from sitting in the APPEAL training for ICEOL (and briefly in hospice volunteer training) is that pain is more than just physical, it can also be emotional and psychosocial. When one is in pain it may be one or all three parts of pain, but being in pain can affect the rest of our being and so this is why hospice sees pain management as highly important so that patients' pain is not interfering with their ability to live out the rest of their life as well as possible.

The next patient we saw was Tabitha*, and active elderly woman with dementia. During our brief visit with her she was very outgoing and eager to communicate. Tabitha may be my most difficult patient to visit with because of how the dementia affects her ability to communicate, and this makes me a bit anxious because I have never been around someone with dementia before. As we were at the facility Danny was contacted by a family and asked to come for a visit. Although he had been by their house just two days before the family felt as if the end were near and would like him to come by and so we left the facility quickly to get to the family's house. The woman we would be seeing was 54 years old with colon cancer. When we arrived I was quickly introduced to the family, meeting her sons and their fiances, and her mother, along with the hospice nurse who happened to be there. Once the introductions were made we went upstairs to see her and as soon as Danny approached her bed the woman took her final breaths and passed just as I was entering the room. After knowing this family for five minutes I was thrust into a very intimate and personal time in their lives as they witness their mother/daughter die. I had no words to say, especially as a completely stranger, but I think in that moment what the family needed the most was our presence, and not our words. Luckily Danny was there and offered a blessing over her as she passed, some scripture (Psalm 23, John 14, Revelation 21) several minutes later and led a prayer for the family. I felt somewhat helpless watching them grieve and also somewhat awkward being a completely stranger in this intimate moment of their lives, not knowing them and not getting the chance to meet her before she died. Danny and I ended up staying for the next couple hours with the family sitting/standing with them, talking with them, and waiting for the funeral home to come remove her body. It is a bit hard to describe all the emotions I felt in that experience having witness a woman die right before me and be amidst a grieving family. My heart went out to them as I stood around them crying over her and standing by her bedside, but I questioned what was appropriate to do as a complete stranger and wanting to respect their space. As we stayed with them and were leaving it seemed that the family desired Danny's presence because he had been with them before, but they were also thankful for my presence. They even hugged me as we left although I had only known them for a short two hours, but that two hour journey was a most sacred and intimate time of their lives.

This entry is already so long so I will break for now, but definitely more to come later!